Falciform ligament abscess with portal pyemia in a newborn

Abscess of ligamentum teres hepatis post-endoscopic retrograde cholangiopancreatography: A case report and a literature review

Abscess of the ligamentum teres hepatis has been described in the medical literature as an extremely rare clinical entity, which often presents a diagnostic dilemma. A 68-year-old man was hospitalized for upper abdominal pain and obstructive jaundice. The patient presented with low-grade intermittent fever. Laboratory investigations showed a white blood cell count of 32.38 × 10⁹/L, a C-reactive protein level of 247.86 mg/L, abnormal liver enzyme and bilirubin levels, and elevated serum levels of amylase and lipase. He was first diagnosed with acute biliary pancreatitis. A computational tomography scan and magnetic resonance cholangiopancreatography revealed obstructive choledocholithiasis and cholecystolithiasis. The patient received preoperative antibiotics and symptomatic treatments for 5 days, followed by endoscopic retrograde cholangiopancreatography and a subsequent duodenal papilla incision to extract pigment and cholesterol gallstones. The patient recovered and was discharged on the fifth day after surgery. However, 10 days later, the patient was readmitted for the recurrence of acute calculous cholecystitis. Laboratory tests showed increases in total and direct bilirubin, γ-glutamyltransferase, and alkaline phosphatase, but not inflammatory parameters. After the patient’s nutritional status improved on the 11th day after admission, a laparoscopic cholecystectomy was performed. Intraoperative exploration revealed extensive abdominal adhesions; a thickened edematous gallbladder wall; and an unexpected abscess of the ligamentum teres hepatis. Pus aspiration was performed laparoscopically after laparoscopic cholecystectomy, and to ensure elimination of the abscess, ultrasound-guided pus aspiration was also performed 1 week later. Fortunately, the patient made an uneventful recovery and was discharged with a drain tube on the 16th day after surgery. Doppler ultrasound indicated that the abscess had completely disappeared 2 weeks after discharge. This case highlights an unusual presentation of a ligamentum teres hepatis abscess caused by obstructive cholangitis but that appeared after the choledocholithiasis was resolved. However, the mechanism of abscess formation remained uncertain.

Falciform ligament abscess secondary to a ruptured liver abscess in a child: a case report

Abscess of the liver ligaments is extremely rare, and abscess of the falciform ligament has been sporadically reported. We report the case of a 3 years old male who presented with a three days history of right upper quadrant abdominal pain, fever and nausea. The ultrasound and computed tomography (CT) scan showed an abdominal wall abscess located anterior to the liver. The patient underwent surgery. Abscess of the falciform ligament secondary to a ruptured liver abscess was found. Excision of the falciform ligament including the abscess was performed. Although pathology of the falciform ligament is rare, it should be included in the differential diagnosis of acute abdomen.

Spontaneous inflammation and necrosis of the falciform and round ligaments: a case report and review of the literature

Background

Necrosis of the falciform and round ligaments is extremely rare, thus making the diagnosis challenging. It is often misdiagnosed as gallbladder pathology due to the presenting symptoms. Due to the rarity of this pathology, there is limited literature available.

Case presentation

A 53-year-old white man presented to our hospital with signs and symptoms of gallbladder pain but turned out to have the rare entity of necrosis of the falciform and round ligaments. An extensive review of the world literature was performed using PubMed. Manual cross-referencing of reference lists was performed to obtain all available articles. The personal operative log of the senior author was also searched to reveal one additional case. Statistical analysis was descriptive only, given the small number of reported cases. Thirty-nine articles were found, among which forty-three case were identified, and one additional case was extracted from the operative log of the senior author. Unlike previous reports, we found that isolated inflammation and necrosis of the ligaments occurs at nearly the same frequency in both men and women, not predominantly in women as previously reported in smaller series. The mean age at presentation was 59.5 years old, and cases were typically initially diagnosed as gallbladder pathology, most commonly acute cholecystitis. Computed tomography more frequently than ultrasound revealed the falciform and round-ligament pathology.

Conclusions

Isolated falciform and round-ligament inflammation and necrosis is a rare condition that is difficult to diagnose because it can present mimicking a wide variety of intra-abdominal pathologies, particularly gallbladder pathologies. It is often best treated by laparoscopic resection. Unlike prior reports, our review of the literature, which is the largest that we know of to date, shows that males and females are equally affected. Greater awareness of this entity will aid in future diagnosis.

Falciform ligament abscess after omphalitis: report of a case

A falciform ligament abscess is a rare type of intra-abdominal abscess. A 2-yr-old male, who had omphalitis two months previously, presented with a fever and right upper quadrant abdominal pain. The ultrasound and CT scan showed an abdominal wall abscess located anterior to the liver, which was refractory to conservative management with percutaneous drainage and antibiotics. On the third recurrence, surgical exploration was performed and revealed an abscess arising from the falciform ligament; the falciform ligament was excised. A follow up ultrasound confirmed complete resolution of the abscess with no further recurrence.